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Indications/Uses
Listed in Dosage.
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Dosage/Direction for Use
Adult: IV Hypercalcaemia of malignancy 15-90 mg as a single infusion or in divided doses over 2-4 consecutive days. Osteolytic lesions associated w/ multiple myeloma; Osteolytic bone metastases 90 mg as a single infusion 3-4 wkly. Paget's disease of bone 30 mg once wkly by infusion for 6 wk, alternatively, 30 mg in the 1st wk, then 3 doses of 60 mg every other wk; may repeat course 6 mthly when clinically indicated. Max infusion rate: 60 mg/hr.
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Contraindications
Lactation.
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Special Precautions
Patient w/ cardiac disease, previous thyroid surgery; pre-existing anaemia, leucopenia or thrombocytopenia. Renal impairment. Elderly. Pregnancy. Patient Counselling Rarely, this drug may cause somnolence and/or dizziness, if affected, do not drive or operate machinery. Maintain good oral hygiene and adequate hydration. Monitoring Parameters Monitor renal function; serum electrolytes, including Ca, phosphate, Mg and K; CBC w/ differential. Perform routine dental check up.
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Adverse Reactions
Renal toxicity, fever and flu-like symptoms, CNS effects (e.g. agitation, confusion, dizziness, lethargy, insomnia, somnolence), seizures, hallucinations, hypocalcaemia, hypophosphataemia, hypomagnesaemia, hypokalaemia, hypotension, HTN, anaemia, thrombocytopenia, lymphocytopenia; osteonecrosis of the jaw (cancer patient), femoral fractures (long term treatment). Rarely, hypernatraemia, hyperkalaemia, bronchospasm, interstitial pneumonitis.
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ROUTE(S) : IV: C
ROUTE(S) : Parenteral: D
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Drug Interactions
Enhanced hypocalcaemic effect w/ aminoglycosides. Increased nephrotoxic effect w/ thalidomide. Enhanced adverse effects w/ NSAIDs. Synergistic effect w/ calcitonin in patients w/ severe hypercalcaemia. Concomitant use w/ other bisphosphonates, other antihypercalcaemic agents and calcitonin may lead to hypocalcaemia w/ associated clinical symptoms (e.g. paraesthesia, tetany, hypotension).
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CIMS Class
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ATC Classification
M05BA03 - pamidronic acid ; Belongs to the class of bisphosphonates. Used in the treatment of bone diseases.
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